Renal and Urologic System Flashcards
The Nephron
filters fluid. reabsorbs fluid. forms a filtrate of protein- free plasma. maintains body fluid volume. maintains electrolyte composition. maintains body pH within narrow limits
Glmerulus/ Bowman’s Capsule
kidney receives 20% of cardiac output
20% of plasma is filtered into the renal tubules
urinary output= 1.5 L per day so most fluid is reabsorbed back from the tubules
Glomerular Filtration Rate
rate of PLASMA filtration by Glomerulus. Best overall estimate of renal FUNCTION
What is used to measure GFR
creatinine clearance (a muscle metabolism byproduct and has fairly constant plasma level)
plasma creatinine concentration level alone
used to monitor GFR. substantial GFR changes may be reflected in relatively small plasma creatinine changes
SENSITIVE test for renal function. Inversely related to GFR
BUN
urea nitrogen in the blood.
clinically relevant labs for kidney disease
Urinalysis
(color, turbidity, protein, pH, specific gravity, sediment*, supernatant) best test for infectious agents and foreign materials such as toxins, drugs
Diuretics
inhibit Na+ uptake (reduced removal from tubular fluid) so more H2O remains in the tubule and urine
What do you see clinically when someone takes a diuretic?
increased urination/micturition
decreased BP
decreased edema
decreased CHF
pathologies of the renal system
infections (UTI, pyelonephritis) cancer (renal cell carcinoma, bladder cancer) renal cystic disease renal calculi chronic renal failure glomerulonephritis (nephrotic syndrome, nephritic syndrome) neurogenic disorders urinary incontinence
UTI symptoms
urethritis (inflammation/ pain at the urethral opening. painful urination)
cystitis/bladder infection (painful urination, frequent urination, an urgent need to urinate, urine may be cloudy or bloody, fever is sometimes present (fever may not be present for older adults so look for CONFUSION)
cystitis (aka bladder infection)
dysuria (painful urination), urinary frequency, urinary urgency, suprapubic pain, low back pain, cloudy urine, bloody urine, flank pain
pyelonephritis (kidney infection)
symptoms suggesting bladder infections. usually abrupt onset. high fever or chills, BACK PAIN localized around the infected kidney is quite common ranging from mild discomfort to sharp, stabbing pain. Nausea and vomiting also possible
kidney/ urinary tract infections- treatment
antibiotics
increased fluids
consider Lactobacillus acidophilus to prevent yeast growth when taking antibiotics
if person does not show improvements within 48-72 hours, contact physician
Renal Cell Carcinoma
malignant tumor; 80-90% of all renal neoplasms
M (over 60) x2> F
metastasis to lungs, skeleton
Renal Cell Carcinoma signs and symptoms
bloody urine, abdominal/ flank pain, palpable mass; can produce HTN, hyperparathyroidism
only 10% of cases (poor prognosis)
hematuria (blood in urine) 50% of cases
Renal Cell Carcinoma Eval and Treat
radiographic imaging, surgical removal
Renal Cell Carcinoma: Risk Factors
Tobacco use (smoking), obesity, HTN (d/t diuretic use), decreased fruits and vegetables in diet, increased red meat in diet, occupational toxins (solvents, asbestos)
Bladder Cancer
Transitional cell cancer.
M 4x > W
metastses to bone or perimetric lymph nodes may cause low BP
Bladder cancer (signs and symptoms)
hematuria (blood in urine), frequency, urgency, dysuria
bladder cancer prevention
tobacco cessation (50% of causes are related to cigarette smoking)
vitamin/ zinc supplements and immunotherapy may reduce recurrence by 40%
screening men at risk over 50 significantly lowers incidence, mortality
Bladder Cancer Treatment
resection of pelvic lymph nodes, prostate/seminal vesicles, uterus; radiation and chemotherapy; salvage cystectomy and/or transplantation
Renal Failure (ARF- acute renal failure) (chronic renal failure)
acute- multiple causes, including impaired renal blood flow (reversible)
chronic- irreversible
Indicators of Chronic Renal Failure
GFR falls
uremia- accumulation of toxins in the blood
signs and symptoms of chronic renal failure
anorexia, nausea, vomiting, fatigue, HTN, pruritus, decreased urine output, edema, neurological changes
Evaluation and treatment of chronic renal failure
(early) regulated food & fluid intake, Na & K restriction; (later) dialysis transplantation
see chronic renal failure stages
go to slide 25
systemic manifestations of kidney failure
urinary, cardiopulm, GI, nervous system, integumentary, hematopoietic, skeletal, endocrine
What is the leading cause of kidney failure?
Diabetic Nephropathy
Dialysis (2 types) both methods have Risk of infection for immunosuppressed patients
hemodialysis- 3x week at 3-4 hours
peritoneal dialysis- 3x daily
dialysis considerations slide
slide 29
PT considerations in CRF
co-morbidities, esp in CV system
immunosuppression when on dialysis
fatigue associated with dialysis (timing of therapy sessions)
impaired O2 transport (w/ dialysis) limits exercise ability; consider Borg scale
exercise may help control BP (consider with HTN)- monitor BP on opposite arm!!!
exercise during HD but some do not want to or the setup isn’t right
PT considerations for CRF (2)
“a timely and effective rehabilitation program can improve quality of life, endurance, and functional abilities toward greater independence
4-6x per week, low capacity interval training (30min)
VO2 Max is 1/3 - 1/2 normal rates
positive s&s for anemia, fatigue, mm wasting, reduced work capacity, reduced caridiac performance and reduced mm mass
improvement shown with 40-70% target HR 3 times a week
Neurogenic Bladder
spastic bladder dysfunction
hypotonic (flaccid) bladder dysfunction
pathophysiology: interrupted innervation results in loss of control; may result in partial or complete urinary retention, incontinence, urgency or frequency
Neurogenic bladder s&s
burning sensation, no pain; infection commonly develops in spastic bladder
neurogenic bladder eval and treat
catheterization, bladder training, surgery, pharmacologic interventions
Examples Urinary Incontinence
functional incontinence, overflow incontinence, stress incontinence, urge incontinence
functional incontinence
normal control but difficulty getting to toilet or facilities (d/t decreased locomotion ability)
overflow incontinence
dribbling with a constantly full bladder; occurs when urinary outlet is obstructed. obstruction in renal system
Stress incontinence
insufficiency (“weakness”) of pelvic floor muscles. uncontrollable voiding when intravesical pressure> extravesical pressure (giggle, coughing, sneezing, exercise, lifting) KEGELS
Urge incontinence
hypertonicity of bladder or pelvic floor muscles. sudden and uncontrollable need to void; suggests neurologic condition (spastic bladder)
1 or more episode per week are 34% more likely to sustain fracture due to falls at night
